title: A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke.
abstract: OBJECTIVE
  To systematically review the evidence on the effects of an ankle-foot orthosis on gait biomechanics after stroke.
  
  
  METHODS
  The following databases were searched; AMED, CINHAL, Cochrane Library (Stroke section), Medline, PubMed, Science Direct and Scopus. Previous reviews, reference lists and citation tracking of the selected articles were screened and the authors of selected trials contacted for any further unpublished data.
  
  
  METHODS
  Controlled trials of an ankle-foot orthosis on gait biomechanics in stroke survivors were identified. A modified PEDro score evaluated trial quality; those scoring 4/8 or more were selected. Information on the trial design, population, intervention, outcomes, and mean and standard deviation values for the treatment and control groups were extracted. Continuous outcomes were pooled according to their mean difference and 95% confidence intervals in a fixed-effect model.
  
  
  RESULTS
  Twenty trials involving 314 participants were selected. An ankle-foot orthosis had a positive effect on ankle kinematics (P < 0.00001-0.0002); knee kinematics in stance phase (P < 0.0001-0.01); kinetics (P = 0.0001) and energy cost (P = 0.004), but not on knee kinematics in swing phase (P = 0.84), hip kinematics (P < 0.18-0.89) or energy expenditure (P = 0.43). There were insufficient data for pooled analysis of individual joint moments, muscle activity or spasticity. All trials, except one, evaluated immediate effects only.
  
  
  CONCLUSIONS
  An ankle-foot orthosis can improve the ankle and knee kinematics, kinetics and energy cost of walking in stroke survivors.
authors.affiliation: Stroke and Vascular Research Centre and School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK. Sarah.Tyson@manchester.ac.uk
authors.forename: S F
authors.initials: SF
authors.lastname: Tyson
authors.forename: E
authors.initials: E
authors.lastname: Sadeghi-Demneh
authors.forename: C J
authors.initials: CJ
authors.lastname: Nester
mesh_terms: D000843:Ankle Joint / Q000502:physiology / Q000503:physiopathology*; D001696:Biomechanical Phenomena / Q000502:physiology; D001915:Braces; D018849:Controlled Clinical Trials as Topic; D016206:Databases, Bibliographic; D061826:Foot Orthoses; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016138:Walking / Q000502:physiology*
keywords: Foot and ankle; biomechanics; gait analysis; orthoses; stroke